Opinion: Medicare needs to update its wheelchair coverage for the 21st century

Both of us have spent much of our lives in wheelchairs. But not just any wheelchairs. Ours are equipped with power seat elevation and standing technologies individually configured to meet our needs.

At the push of a button, our wheelchairs can elevate us to eye level with a nondisabled person or position us in a “standing” posture. We can complete everyday tasks like going to the bathroom or stocking kitchen cabinets that are nearly impossible for those who spend all or nearly all their time in wheelchairs without these capabilities.

Millions of our peers do not have access to this equipment. Medicare — the primary health insurer for older adults as well as for many people with spinal cord injuries, muscular dystrophy, ALS, and other long-term disabilities — doesn’t cover wheelchairs equipped with these technologies.


That’s short-sighted, given that these technologies can yield savings by helping people avoid costly health complications. More importantly, Medicare’s policy misses the opportunity to improve the lives of Americans with mobility disabilities. These devices enable people like us to enjoy healthier lives with dignity and independence.

Over the past 25 years, seat elevation and standing systems for power wheelchairs have revolutionized life for people with disabilities. With a lift attachment, an individual can raise their seat to work at a desk or cook. Standing technology has invaluable health benefits, like promoting good circulation to avoid blood clots and bed sores and reducing the risk of osteoporosis.


To be sure, this technology comes at a price. Complex power wheelchairs with seat elevation and standing support capabilities can cost $10,000 or more.

Many people can’t afford that out of pocket. And Medicare has long declined to cover seat elevation and standing systems on the grounds that they are “not primarily medical in nature.”

That’s a dubious claim. Clinical research shows that these technologies tangibly improve people’s health and avert serious and expensive injuries. Our lives are a testament to that research.

One of us (P.A.L.) became a wheelchair user after a spinal cord injury in 1993. It was devastating to lose the ability to perform simple tasks like loading the washing machine or grabbing a snack from the refrigerator. Using the stovetop became a dangerous ordeal, and I have the burns to prove it.

Thankfully, my wheelchair is now equipped with seat elevation technology. I once again feel like I’m a productive member of my family — that I can carry my own load. In addition to giving me independence, the technology has eased my wife’s caregiving role. She no longer has to help me transfer out of my wheelchair five to eight times a day.

The other (J.M.) has lived with muscular dystrophy for decades, which ultimately robbed him of the ability to walk.

In 1997, I learned that being stuck with using a regular wheelchair raised my risk of developing skin ulcers, urinary tract infections, diabetes, and renal failure. My doctor also warned that I could suffer “contractures” — conditions where the tendons and muscles in the legs stiffen up, resulting in painful deformities.

Addressing contractures can require barbaric procedures, like completely severing a stiffened tendon or muscle. Thankfully, with the help of a power wheelchair with seat elevation technology, I was able to avoid contractures and the painful treatments they entail.

I also have experience with standing technology. In 2017, I was diagnosed with bone loss due to vitamin D deficiency. A power wheelchair with a standing feature has helped minimize fracture risk by eliminating transfers and strengthening my bones. Thanks to the standing frame, my bone loss is noticeably improving.

Given our experiences, how could anyone say that seat elevation and standing technologies in power wheelchairs are not “medically necessary”?

Seat elevation and standing systems don’t just improve wheelchair users’ physical health, but their mental health, too. For a wheelchair user, being able to have a conversation with a friend, loved one, or stranger on the same visual plane is a welcome change that can make us feel less socially isolated and less like people are looking down on us — figuratively and literally.

Medicare should reconsider its policies, and there’s a sign it might do so. The Centers for Medicare and Medicaid Services have asked for public comment on whether to cover power seat elevation technology (the deadline for submitting comments is Sept. 14). But the agency has remained silent about when and how it will consider covering power standing systems.

It’s unconscionable, and inequitable, that only privileged individuals can afford these life-changing technologies while Americans of more modest means must suffer eminently preventable physical and mental health problems by using outmoded wheelchairs.

It’s past time for Medicare to recognize that these systems are primarily medical in nature — and to offer coverage for the beneficiaries who need them.

Paul Amadeus Lane is the accessibility specialist and tech access lead for United Spinal Association’s Tech Access Initiative. Jim Meade is a disability advocate. Both are affiliated with the ITEM Coalition, an organization that raises awareness of and builds support for policies to enhance access to assistive devices, technologies, and related services for people with disabilities and chronic conditions.

Source: STAT